Expanding our view of health

When it comes to the state of our health, there is a glaring disconnect in the US, says Sandro Galea. We spend far more on health care per capita than any country, yet we’re far less healthy than those in many other developed countries as measured by all sorts of indicators, including life expectancy.
Our cutting-edge new medical treatments and drugs are wonderful, says the dean of the Boston University School of Public Health. But he says we are focusing on them to the exclusion of all sorts of factors in everyday life that have a profound effect on health. Galea joined John McDonough and Paul Hattis for the latest installment of “Health or Consequences” on the Codcast, where he unspooled his take on how we’re missing the boat when it comes to promoting good health.

A native of Malta who trained as in emergency medicine in Canada, Galea described his migration from work as an acute care doctor to the field of public health. When treating patients on the frontlines of medicine, “you are sharply aware of what really shapes health,” he said. “What drives health is not so much the immediate experience, but a lifetime of experiences in the world around people and the context in which people live.”

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That broader view takes into account social and economic factors, from housing to transportation to exposure to gun violence, environmental policy, and the sort of dietary habits being promoted.

The author or coauthor of more 800 scientific articles and 13 books, Galea sets out his broad take in a new book, due out in May, titled Well: What We Need to Talk About When We Talk About Health.

Galea says many health indicators in the US started deviating from those of other advanced countries in the 1980s. “It really speaks to a shift in the past 30, 40 years in this country toward a very particular conception of a clinical, medical curative-first approach that really runs counter to this idea that our health ultimately is generated by the world around us,” he said. Galea ties the troubling trends in US health indicators to the “ascendance of what is broadly called neoliberal economic policies,” which “ultimately put a lot more confidence, a lot more faith in individual market-driven forces and started this systematic disinvestment from a more central investment in resources that keep us all healthy.”

Galea questioned the state health policy focus in recent years on keeping health care cost increases in check. “I think we’re missing the whole point,” he said. Despite the state’s “relative enlightenment,” he said Massachusetts “is also behind in wrapping its brain around this simple notion that to generate health we need a careful look at all these other non-health factors — that ultimately these factors all matter to health.”

Galea said he celebrates the gains in coverage from the Affordable Care Act and the tremendous advances from new medical treatments and drugs, many of them developed in the Boston area.

“My quibble is with the fact this is all we’re doing,” he said, referring to the neglect of public health policies and can keep people from needing access to those cutting-edge new treatments to begin with.

“Why is it that every headline in the country is not about the fact this is the biggest downturn in our life expectancy since the 1918 flu pandemic,” he said of data showing a drop in US life expectancy for three years in a row. “That should cause serious alarm,” he said.

All of that said, Galea points out the importance of taking a long view of the state of health.

“I consider myself a radical optimist,” he said. “We can’t forget that for most of human existence life expectancy was around 40.” It has jumped to about 80 in many countries over the last 150 years, he said.

“So I would much rather be living today than at any other point in human history,” he said. “It is a real privilege to be able to say from that vantage point, how can we get even better? Part of what’s going on right now is we have become complacent, and I don’t think we should allow that to be the case.”

–MICHAEL JONAS

BEACON HILL

Jonathan Cohn argues that Sen. Michael Rodrigues, the new Senate Ways and Means chairman, has taken conservative positions on education, criminal justice, wage law, and immigration enforcement and he could move the Senate to the right. (CommonWealth)

Salem lawmakers want more state oversight of opioids in medical facilities after the theft of more than 18,000 pills from Beverly Hospital. (Gloucester Daily Times)

MUNICIPAL MATTERS

Pittsfield’s city council on Tuesday will consider a proposed ordinance banning single-use plastic bags. (The Berkshire Eagle)

A Herald editorial suggests it may already be time for Elizabeth Warren to throw in the towel, saying her presidential campaign seems to be stalling out of the gate.

David Bernstein writes for Politico that Donald Trump is doing surprisingly well among Hispanics, something that should worry Democrats a lot about the 2020 presidential race as well Senate contests.

BUSINESS/ECONOMY

Members of UFCW Local 1445 have authorized a strike after a contract that covers between 8,000 to 9,000 Stop and Shop workers expired Saturday night. (Patriot Ledger)

Facebook has been accused of using misleading privacy policies to try to convince people to share health information and failing to report data breaches. (WBUR)

EDUCATION

Emails obtained through a public records request by the Daily Hampshire Gazette show that the president of financially struggling Hampshire College, was eager last month to announce a non-binding letter of intent for the two institutions for form a partnership, but the college president, Miriam Nelson, now says “we’re not at that stage yet” and other options are being explored.

The new Senate chairman of the Legislature’s education committee, Jason Lewis, says the state may need new revenue to fund an overhaul of the school funding formula. (Boston Globe)

HEALTH/HEALTH CARE

Partners HealthCare has been expanding into neighboring states, and the state intervention to block its sale of South Shore Hospital may have made the health care giant even richer, contends Paul Hattis, who thinks the company should break apart. (CommonWealth)

Rob Restuccia, a founder of the advocacy group Health for All, facing terminal pancreatic cancer, pens a moving account of the long effort to ensure access to health care for all. (Boston Globe)

An Ohio woman has recounted how Keith Ablow, a renowned Newburyport psychiatrist, allegedly began treating her depression, then pursued a romantic relationship, and then became increasingly controlling, asking her to tattoo his name on her thigh. (Eagle-Tribune)

The interim CEO of Partners HealthCare, Dr. Anne Klibanski, has a reputation for mentoring women in the medical field. (Boston Globe)

ARTS/CULTURE

W.E.B. DuBois’s great grandson, Jeffrey Peck, of Houston, is taking on the family’s responsibility for representing the scholar and civil rights writer who was born in Great Barrington more than 150 years ago. (The Berkshire Eagle)

TRANSPORTATION

With road traffic rated the worst in the country, is this the time to raise MBTA fares? (Boston Globe) T General Manager Steve Poftak, in an op-ed, defends the move and says new revenue is being investing in crucial upgrades to the system. (Boston Globe)

ENERGY/ENVIRONMENT

There are low-intensity marine industrial activities – such as vocational schools, robotics testing, waterborne delivery, and ferries – that could fit in well with waterfront restaurants and housing in Boston, according to Tom Skinner, a partner at Durand & Anastas Environmental Strategies Inc. (CommonWealth)

The Herald’s Michael Silverman writes that there’s a “Gold Rush atmosphere swirling around sports betting,” which seems to be on its way here.

Aquinnah tribe leader Cheryl Andrews-Maltais is touting the construction of a new bingo parlor on tribal lands as an economic boost and opportunity for new jobs. (Cape Cod Times)

CRIMINAL JUSTICE/COURTS

Patriots owner Robert Kraft will face charges as early as this afternoon of soliciting a prostitute at a Florida strip mall. (Boston Globe) The Martin County, Florida, sheriff, William Snyder, said the men being charged in connection with prostitution crimes at the Jupiter spa “are the monsters in this case” and added that those who paid for sex there “would not have allowed their dog to be in such wretched conditions.” (Boston Herald) The spa was part of a thriving sex trafficking industry in South Florida. (New York Times)

The New England Center for Investigative Reporting documents in the Sunday Globe magazine the eviction toll exacted on tenants in a booming housing market.